Sepsis resident survival guide
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
- Sepsis = Infection + SIRS
- The presence of systemic inflammatory syndrome (SIRS) is due to many factors. The presence of infection increases the chances of sepsis and increase the SIRS criteria .
- The endothelial dysfunction is the main trigger transforming the localized infection into systemic organ dysfunction
- There is no definitive biomarkers have been associated with the endothelial dysfunction of sepsis.
SIRS diagnosed by 2 or more of the following:
- Tachycardia > 90 bpm
- Tachypnea > 20 breaths per minute or on blood gas, a PaCO2 < 32 mm Hg
- Temperature < 36 (96.8 °F) or > 38 °C (100.4 °F)
- White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/L), or > 10% band forms (immature white blood cells / bandemia).
Sepsisdiagnosed by at least 1of the following signs of organ failure: [HOME]
- '''H'''ypoxemia (arterial oxygen tension [PaO2] < 72 mm Hg at fraction of inspired oxygen [FiO2] 0.21; overt pulmonary disease not the direct cause of hypoxemia)
- Oiguria (urine output < 30 mL or 0.5 mL/kg for at least 1 h)
- Mental status alteration
- Elevated plasma lactate level > 4mg
- Multiple organ dysfunction syndrome (MODS) is the presence of altered organ function in a acutely ill patient whom homeostasis cannot be maintained without intervention.
Causes
Life Threatening Causes
Common Causes
Management
Aggressive therapy with hemodynamic monitoring